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Mini-Mental State Questionnaire: problems with its use in palliative care
1University of Canberra, Australia.
Abstract:
The Mini-Mental State Questionnaire (MMSQ) has been established as a reliable research instrument and is recommended for the early detection of impaired mental status (Fainsinger et al, 1993). Using reflection on a clinical incident, the problems associated with the clinical application of the MMSQ that may outweigh its usefulness are identified. The patient's experience of MMSQ as routine cognitive monitoring can be distressing as the person experiences loss of cognitive ability in a visible way. This experience has a negative influence on the person's quality of life, which is contrary to the essential aim of palliative care. Research evidence suggests that the MMSQ lacks specificity (the ability to detect impaired mental status) because it is affected by pre-morbid ability and intelligence, and therefore cannot be used to assess competence in decision making. Further research on the meaning of losing cognitive ability in terminal illness and other cognitive assessment strategies is required.
Insights
The Mini-Mental State Questionnaire (MMSQ) can distress patients undergoing palliative care by highlighting cognitive decline. Its clinical utility is questioned due to lack of specificity and negative impacts on quality of life.
Area of Science:
- Gerontology
- Palliative Care Medicine
- Neuropsychology
Background:
- The Mini-Mental State Questionnaire (MMSQ) is a recognized tool for detecting cognitive impairment.
- Its application in clinical settings, particularly palliative care, warrants critical evaluation.
Observation:
- Routine cognitive monitoring with the MMSQ can be distressing for patients.
- Patients may experience a visible loss of cognitive ability, negatively impacting their quality of life.
Findings:
- The MMSQ's clinical usefulness may be outweighed by its negative psychological impact on patients.
- Research indicates the MMSQ lacks specificity, being influenced by pre-morbid abilities, limiting its use in assessing decision-making competence.
Implications:
- The distress caused by MMSQ use contradicts the goals of palliative care.
- Further research is needed on the experience of cognitive decline in terminal illness and alternative assessment strategies.